Reflux esophagitis: sequelae and differential diagnosis in infants and children including eosinophilic esophagitis

Area of Science:

• Pediatric Pathology
• Gastroenterology
• Histopathology

Background:

• Gastroesophageal reflux disease (GERD) is a prevalent condition in pediatric populations, often presenting with diverse clinical manifestations that mimic other pathologies.
• Evaluating mucosal biopsies of the proximal gastrointestinal tract is a routine procedure in pediatric pathology to diagnose reflux esophagitis.
• Significant advancements in understanding GERD have occurred since 1997, leading to the identification of new symptoms and therapeutic strategies.

Purpose of the Study:

• To summarize recent advancements in the recognition, diagnosis, and treatment of GERD in infants and children.
• To differentiate GERD from other esophageal conditions, particularly eosinophilic esophagitis.
• To review established histologic criteria for diagnosing reflux esophagitis and discuss ongoing refinements in defining Barrett esophagus.

Main Methods:

• Review of current literature and diagnostic standards for pediatric GERD.
• Comparative analysis of histologic features distinguishing reflux esophagitis from eosinophilic esophagitis.
• Synthesis of updated concepts regarding GERD presentation and management in children.

Main Results:

• Histologic criteria for diagnosing reflux esophagitis have remained consistent.
• Eosinophilic esophagitis has emerged as a distinct entity, previously potentially confused with reflux esophagitis.
• Definitions and diagnostic criteria for Barrett esophagus continue to evolve.

Conclusions:

• Pediatric GERD diagnosis benefits from updated clinical and therapeutic insights.
• Distinguishing eosinophilic esophagitis from GERD is crucial for accurate pediatric esophageal pathology diagnosis.
• Continued refinement in understanding esophageal conditions like Barrett esophagus is necessary.